When_to_Start_RRT_in_AKI

When_to_Start_RRT_in_AKI - When to Start RRT in AKI...

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When to Start RRT in AKI Alexander Usorov, MD 2/24/09
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New Diagnostic Criteria for AKI Acute Dialysis Quality Initiative Plus several Critical Care Societies Equals Acute Kidney Injury Network or AKIN The fundamental goal is to improve the outcomes for patients who are at risk The first AKIN conference was held in Amsterdam in September 2005 Focused on the development of uniform standards for definition and classification of AKI
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RIFLE-AKI
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Indications for RRT in AKI Volume overload unresponsive to diuretics Metabolic acidosis refractory to medical management Intoxication with dialyzable drug or toxin Uremic symptoms Encephalopathy Pericarditis Uremic bleeding Progressive azotemia in the absence of specific symptoms
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Indications are open to interpretations How volume overloaded? What should potassium level be? How severe for metabolic acidosis? What is the definition of diuretic resistance?
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Dose and Modality VA/NIH trial vs Schiffl’s trial Ronco Mehta Vinsonneau (Contniuous venouvenous hemodiafiltration vs intermittent HD for ARF in pts with multiorgan dysfunction syndrome. Lancet 2006)
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Timing? Less data available Early literature (1950s-1960s) is significant for the concept of prophylactic HD in AKI Introduced by Dr. Paul E Teschan
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When_to_Start_RRT_in_AKI - When to Start RRT in AKI...

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